Cervical Cancer

Question 1

How many cases of cervical cancer a year

Answer 1

• 2500 cases year
• 1200 deaths
• 10th most common cancer in women

Question 2

Where and why are rates of cervical cancer higher

Answer 2

• Deprived area
  
  • Less likely to attend screening, get vaccinated
  • More likely to smoke and have worse health behaviours e.g. diet
• Major cause of death in developing world

Question 3

Risk factors (same as virus) for cervical cancer

Answer 3

• 45-55
• Multiple partners
• Early age at first intercourse - transition zone much more susceptible in teenagers
• Older age of partner
• Smoking

Question 4

Which virus causes cervical cancer

Answer 4

• HPV 16 & 18

Question 5

Symptoms of cervical cancer

Answer 5

• Abnormal vaginal bleeding
• Post-coital bleeding
• Intermestrual bleeding/PMB
• Discharge
• Pain - unusual as only in advanced disease

Question 6

How is cervical cancer diagnosed

Answer 6

• Clinical
• Screening detected - pre-cancerous disease
• Biopsy

Question 7

What are the types of cervical cancer

Answer 7

• Squamous carcinoma (80%)
• Adenovcarcinoma (endocervical) rising in relative incidence

Question 8

Types of biopsy in cervical cancer

Answer 8

• Small cervical biopsy
• Large loop excision of the transformation zone (LLETZ)

Question 9

Types of pre-cursor lesion in cervical cancer

Answer 9

• Cervical intraepithelial neoplasia - abnormal proliferation of squamous epithelial cells
  
  • Low grade (CIN1)
  • High grade (CIN2)
• Cervical glandular intraepithelial neoplasia (CGIN)
  
  • Precursor for adenomas

Question 10

What is used to stage cervical cancer

Answer 10

• PET-CT
• MRI

Question 11

How is the invasion of cervical cancer measured

Answer 11

• Stage 1A: invasive cancer identified only microscopically
  
  • 1A1: ≤ 3mm depth and ≤ 7mm diameter (microinvasive)
  • 1A2: ≤ 5mmx7mm
• Stage 1B: clinical tumours confined to the cervix

Question 12

How is the spread of cervical cancer measured

Answer 12

• Local
  
  • Stage 2: vagina (upper 2/3)
  • Stage 3: lower vagina, pelvis
  • Stage 4: bladder, rectum
• Metastases
  
  • Lymphatic - pelvic nodes
  • Blood - liver, lungs, bone

Question 13

Treatment of cervical cancer by stage

Answer 13

• Stage 1A1: type 3 excision of the cervical transition zone or hysterectomy
• Stage 1B-11A: radical hysterectomy or chemo-radiotherapy
• Stage 11B-1V: chemo-radiotherapy

Question 14

What does a radical hysterectomy involve

Answer 14

• Exploration of the pelvic and para-aortic space
• Removal of
  
  • Uterus, cervix, upper vagina
  • Parametria
  • Pelvic nodes
  • Ovaries conserved

Question 15

What therapy is used to treat cervical cancer

Answer 15

• Radiotherapy - external beam x 0 fractions
• Chemo - 5 cycles of cisplatin
• Caesium insertion (24 hours)